Sleep quality in times of Covid-19 pandemic.

BACKGROUND: Due to the 2019 novel coronavirus (COVID-19) disease outbreak, social distancing measures were imposed to control the spread of the pandemic. However, isolation may affect negatively the psychological well-being and impair sleep quality. Our aim was to evaluate the sleep quality of respiratory patients during the COVID-19 pandemic lockdown. METHODS: All patients who underwent a telemedicine appointment from March 30 to April 30 of 2020 were asked to participate in the survey. Sleep difficulties were measured using Jenkins Sleep Scale. RESULTS: The study population consisted of 365 patients (mean age 63.9 years, 55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 78.9% of participants were confined at home without working. Most patients (69.6%) reported at least one sleep difficulty and frequent awakenings was the most prevalent problem. Reporting at least one sleep difficulty was associated with home confinement without working, female gender and diagnosed or suspected SDB, after adjustment for cohabitation status and use of anxiolytics. Home confinement without working was associated with difficulties falling asleep and waking up too early in the morning. Older age was a protective factor for difficulties falling asleep, waking up too early and non-restorative sleep. Notably, SDB patients with good compliance to positive airway pressure therapy were less likely to report sleep difficulties. CONCLUSIONS: Home confinement without working, female gender and SDB may predict a higher risk of reporting sleep difficulties. Medical support during major disasters should be strengthened and potentially delivered through telemedicine, as this comprehensive approach could reduce psychological distress and improve sleep quality.

Polymeric Nanoparticles: Production, Characterization, Toxicology and Ecotoxicology.

Polymeric nanoparticles (NPs) are particles within the size range from 1 to 1000 nm and can be loaded with active compounds entrapped within or surface-adsorbed onto the polymeric core. The term "nanoparticle" stands for both nanocapsules and nanospheres, which are distinguished by the morphological structure. Polymeric NPs have shown great potential for targeted delivery of drugs for the treatment of several diseases. In this review, we discuss the most commonly used methods for the production and characterization of polymeric NPs, the association efficiency of the active compound to the polymeric core, and the in vitro release mechanisms. As the safety of nanoparticles is a high priority, we also discuss the toxicology and ecotoxicology of nanoparticles to humans and to the environment.

Clinical-functional vulnerability in older adults and its impact on primary health care actions

Objective: To describe the prevalence of clinical-functional vulnerability among older adults cared for in a Primary Health Care Unit (PHCU). Methods: This is a retrospective epidemiological study performed through the review of medical records of 950 elderly users of a PHCU in the northeast region of Belo Horizonte, between August 2016 and July 2017. The score obtained with use of the Clinical-functional Vulnerability Index (IVCF-20) evidenced the clinical-functional vulnerability of the older adults. The PHCU health professionals had been trained and had been implementing the IVCF-20 since the end of 2015. In 2016, the application of IVCF-20 was intensified following training of psychology undergraduates who participated in the Health Work Education Program (Programa de Educação pelo Trabalho para a Saúde - PET-Saúde). Descriptive statistics was applied to IVCF-20 data to verify the frequency of frail older adults and individuals at risk for frailty. Pearson's chi-square test was used to verify association between the IVCF-20 classification and the Family Health Teams. Results: Of 950 older adults included in the study, 49.37% (n=469) had mild clinical-functional vulnerability, considered robust; 28.84% (n=274) had moderate vulnerability, considered at risk for frailty; and 21.79% (n=207) had high vulnerability, regarded as frail. Conclusion: A high prevalence of clinical-functional vulnerability (mild, moderate, and high) was observed among older adults attended to at primary health care services. Screening with IVCF-20 can prove useful for early identification of vulnerable older adults and to indicate the focus of health promotion and preventive interventions. (AU)

Kaolin particle film application stimulates photoassimilate synthesis and modifies the primary metabolome of grape leaves.

Water scarcity is associated with extreme temperatures and high irradiance, and significantly and increasingly affects grapevine yield and quality. In this context, the foliar application of kaolin, a chemically inert mineral that greatly reflects ultraviolet and infrared radiations, as well as, in part, photosynthetically active radiation, has recently been shown to decrease photoinhibition in mature leaves. Here, the influence of this particle film on grapevine leaf metabolome and carbohydrate metabolism was evaluated. Molecular mechanisms underlying photoassimilate synthesis, metabolism and transport capacity were assessed by targeted transcriptional analyses and enzymatic activity assays. Kaolin application increased sucrose concentration in leaves and sucrose transport/phloem loading capacity, as suggested by the stimulation of the transcription of sucrose transporters VvSUC12 and VvSUC27 in these source organs. While the biosynthesis of sucrose increased, as evidenced by higher sucrose content and sucrose phosphate synthase (SPS) activity in leaves, the concentration of transitory starch before the dark period remained unaltered, despite a higher total amylolytic activity in the leaves of kaolin-treated plants. Metabolomic analysis by GC-TOF-MS showed that the application of kaolin enhanced the amounts of simple sugars, including fructose, maltose, xylulose, xylose, sophorose, ribose and erythrose; sugars-phosphate, like mannose-6-Pi, hexose-6-Pi, glucose-6-Pi, glucose-1-Pi, glycerol-α-Pi and fructose-6-Pi; polyols, like xylitol, maltitol, lactitol, glycerol, galactinol and erythritol; organic acids and amino acids.

Kaolin Foliar Application Has a Stimulatory Effect on Phenylpropanoid and Flavonoid Pathways in Grape Berries.

Drought, elevated air temperature, and high evaporative demand are increasingly frequent during summer in grape growing areas like the Mediterranean basin, limiting grapevine productivity and berry quality. The foliar exogenous application of kaolin, a radiation-reflecting inert mineral, has proven effective in mitigating the negative impacts of these abiotic stresses in grapevine and other fruit crops, however, little is known about its influence on the composition of the grape berry and on key molecular mechanisms and metabolic pathways notably important for grape berry quality parameters. Here, we performed a thorough molecular and biochemical analysis to assess how foliar application of kaolin influences major secondary metabolism pathways associated with berry quality-traits, leading to biosynthesis of phenolics and anthocyanins, with a focus on the phenylpropanoid, flavonoid (both flavonol- and anthocyanin-biosynthetic) and stilbenoid pathways. In grape berries from different ripening stages, targeted transcriptional analysis by qPCR revealed that several genes involved in these pathways-VvPAL1, VvC4H1, VvSTSs, VvCHS1, VvFLS1, VvDFR, and VvUFGT-were more expressed in response to the foliar kaolin treatment, particularly in the latter maturation phases. In agreement, enzymatic activities of phenylalanine ammonia lyase (PAL), flavonol synthase (FLS), and UDP-glucose:flavonoid 3-O-glucosyltransferase (UFGT) were about two-fold higher in mature or fully mature berries from kaolin-treated plants, suggesting regulation also at a transcriptional level. The expression of the glutathione S-transferase VvGST4, and of the tonoplast anthocyanin transporters VvMATE1 and VvABCC1 were also all significantly increased at véraison and in mature berries, thus, when anthocyanins start to accumulate in the vacuole, in agreement with previously observed higher total concentrations of phenolics and anthocyanins in berries from kaolin-treated plants, especially at full maturity stage. Metabolomic analysis by reverse phase LC-QTOF-MS confirmed several kaolin-induced modifications including a significant increase in the quantities of several secondary metabolites including flavonoids and anthocyanins in the latter ripening stages, probably resulting from the general stimulation of the phenylpropanoid and flavonoid pathways.

Imagem da enfermeira durante a Primeira Guerra Mundial / Image of nurses during World War I / Imagen de la enfermera durante la Primera Guerra Mundial

Objetivo: analisar os desenhos inspirados em enfermeiras veiculados na imprensa, com destaque dos seus atributos pessoais nas circunstâncias da Primeira Guerra Mundial. Método: optou-se por analisar os documentos à luz da semiótica para decodifica-los, articulando-os simultaneamente com a história. De acordo com os critérios de seleção dos documentos, foram analisados três desenhos veiculados pela Revista da Semana, com base nos conceitos de "plano de expressão" e "plano de conteúdo". Resultados: nos desenhos em análise evidenciam-se o véu, o braçal e a cruz como os atributos pessoais mais marcantes das mulheres em destaque, associados a outros atributos como asas e cenas de cuidados aos feridos. Conclusão: os signos revelaram possível estratégia de manipulação simbólica para representar a imagem da enfermeira, que pautava na sua prática bondade e caridade. Ressalta-se que o braçal com cruz, por ser portador do significado de neutralidade, caracterizou o cuidar sem distinção, uma das referências da Cruz Vermelha.(AU)

Objective: to analyze the drawings inspired by nurses and published by the press, especially their personal attributes in the circumstances of World War I. Method: we chose to analyze the documents in the light of semiotics to decode them, relating them simultaneously to history. According to the criteria for the selection of the documents, we analyzed three drawings published by Revista da Semana magazine, based on the concepts of "expression plane" and "content plane". Results: the drawings analyzed showed a veil, an armband and the cross as the most remarkable personal attributes of these women, associated with other attributes such as wings and scenes of care provided to war-wounded patients. Conclusion: the signs revealed a possible strategy of symbolic manipulation to represent the image of nurses who based their practice on kindness and charity. It is worth mentioning that the armband with a cross, which means neutrality, characterized care provided without any distinction, one of the references of the Red Cross.(AU)

Objetivo: analizar los dibujos inspirados en enfermeras publicados por la prensa, con destaque de sus atributos personales en las circunstancias de la Primera Guerra Mundial. Método: fueron analizados los documentos a la luz de la semiótica para decodificarlos, articulándolos simultáneamente con la historia. Según los criterios de selección de los documentos, fueron analizados tres dibujos publicados por la Revista da Semana, con base en los conceptos de "plano de expresión" y "plano de contenido". Resultados: en los dibujos analizados se destacan el velo, el brazalete y la cruz como los atributos personales más notables de esas mujeres, asociados con otros atributos como alas y escenas de la atención de heridos. Conclusión: los signos revelaron una posible estrategia de manipulación simbólica para representar la imagen de la enfermera, que basaba su práctica en la bondad y caridad. Cabe señalar que el brazalete con cruz, por tener el significado de neutralidad, caracterizó la atención sin distinción alguna, una de las referencias de la Cruz Roja.(AU)

Use of enzymes in extraction of polyhydroxyalkanoates produced by Cupriavidus necator.

Poly(3-hydroxybutyrate) (P(3HB)) and its copolymer poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (P(3HB-co-3HV), are biodegradable thermoplastic polymers. They are members of the polyhydroxyalkanoate (PHA) family, synthesized and accumulated as a carbon and energy reserve by a variety of microorganisms. The aim of this study was to evaluate the use of the proteases Corolase® L10, Alcalase® 2.4L, Corolase® 7089 and Protemax® FC and glycosidases Celumax® BC, Rohament® CL and Rohalase® Barley for the recovery of P(3HB) and P(3HB-co-3HV) synthesized by Cupriavidus necator. The enzyme Celumax® BC provided better lysis of the bacterial cell membrane and the results for the optimization of the operating conditions showed that this enzyme is most stable in acetate buffer at pH 4.0, bath at 60°C, hydrolysis time of 1 h and concentration of 0.02% (w/w). The optimization of the operating conditions showed that the enzyme Celumax® BC provided better lysis of the bacterial cell in acetate buffer at pH 4.0, bath at 60°C, hydrolysis time of 1 h and concentration of 0.02% (w/w). These conditions resulted in lysis of the membrane of the bacteria with a recovery of 93.2% P(3HB-co-3HV) with 94% purity. The results showed that the use of enzymes for the polymer extraction is an efficient process that assists in the cell disruption of Cupriavidus necator.

Dendritic cells derived from metastatic cancer patients vaccinated with allogeneic dendritic cell-autologous tumor cell hybrids express more CD86 and induce higher levels of interferon-gamma in mixed lymphocyte reactions.

Dendritic cells (DCs) are highly effective antigen-presenting cells that, when derived from cancer patients, seem to be functionally deficient. Herein, we show that vaccination with allogeneic DC-autologous tumor cell hybrids affects the phenotype and improves the function of monocyte-derived DCs (Mo-DCs) from cancer patients. Mononuclear cells were isolated from patients' peripheral blood by density gradient centrifugation, and adherent cells were cultured in medium containing GM-CSF plus IL-4 and, after 5 days, TNF-alpha. After 2 more days, Mo-DCs were harvested and their CD80, CD86, and CD83 expression was assessed by flow cytometry. They were also used as stimulators in mixed lymphocyte reactions (MLR), where IFN-gamma production was measured by ELISA. Mo-DCs from unvaccinated patients expressed significantly lower levels of CD86, and tended to express lower levels of CD83 than Mo-DCs from healthy donors. However, Mo-DCs generated after hybrid cell vaccination presented increased expression of the same markers and induced significantly higher levels of IFN-gamma in MLR. These results indicate that the use of allogeneic DC-based cancer vaccines induces recovery of DC function in metastatic cancer patients and, therefore, could precede the use of autologous DCs for vaccine preparation. Such an approach could be relevant and should be investigated in clinical trials.

Dendritic cell-tumor cell hybrid vaccination for metastatic cancer.

Dendritic cells are the most potent antigen-presenting cells, and the possibility of their use for cancer vaccination has renewed the interest in this therapeutic modality. Nevertheless, the ideal immunization protocol with these cells has not been described yet. In this paper we describe the preliminary results of a protocol using autologous tumor and allogeneic dendritic hybrid cell vaccination every 6 weeks, for metastatic melanoma and renal cell carcinoma (RCC) patients. Thirty-five patients were enrolled between March 2001 and March 2003. Though all patients included presented with large tumor burdens and progressive diseases, 71% of them experienced stability after vaccination, with durations up to 19 months. Among RCC patients 3/22 (14%) presented objective responses. The median time to progression was 4 months for melanoma and 5.7 months for RCC patients; no significant untoward effects were noted. Furthermore, immune function, as evaluated by cutaneous delayed-type hypersensitivity reactions to recall antigens and by peripheral blood proliferative responses to tumor-specific and nonspecific stimuli, presented a clear tendency to recover in vaccinated patients. These data indicate that dendritic cell-tumor cell hybrid vaccination affects the natural history of advanced cancer and provide support for its study in less advanced patients, who should, more likely, benefit even more from this approach.

Negative immunodiffusion test results obtained with sera of paracoccidioidomycosis patients may be related to low-avidity immunoglobulin G2 antibodies directed against carbohydrate epitopes.

Immunodiffusion (ID) is the serologic test most frequently used for the diagnosis and posttherapy follow-up of patients with paracoccidioidomycosis (PCM). The ID test is highly specific (100%), but its sensitivity is relatively low (90%), leading to false-negative results. The aim of this study was to determine the profiles of antibodies in sera from patients with proven PCM and with negative results in the ID test (IDneg) versus positive results in the ID test (IDpos). We analyzed 46 sera from patients with active PCM for total immunoglobulin G (IgG) and IgG subclass responses to Paracoccidioides brasiliensis gp43 antigen (treated or not treated with sodium metaperiodate) by enzyme-linked immunosorbent assay and immunoblotting. Immunoblotting showed that both IDneg and IDpos sera recognized predominantly the gp43 fraction of the P. brasiliensis antigen used in the ID test. IDneg sera contain low-avidity antibodies, low levels of specific IgG (total) and IgG1, and high levels of IgG2 compared with IDpos sera. The antibodies present in IDneg sera were predominantly directed against carbohydrate epitopes, since treatment with sodium metaperiodate resulted in a significant decrease in antibody reactivity. These data suggest that the lack of reactivity of sera from PCM patients in the ID test may be related to the production of low-avidity IgG2 antibodies directed against carbohydrate epitopes.

Avaliaçäo de duas estrategias ventilatorias na sindrome de angustia respiratoria aguda de evolucao severa / Evaluation of two ventilatory approaches in patients with severe acute respiratory distress syndrome

Objetivo: Comparar o perfil de oxigenação,mecânica torácica e mortalidade entre duas estratégias distintas de suporte ventilatório na SARA em pacientes com escore de lesão pulmonar > 2.5. Perfil: Análise prospectiva. Local: UTI multidisciplinar de um hospital publico terciário nao universitário. Paciente: 112 pacientes de ambos os sexos com doenças de gravidade semelhante,divididos em dois grupos,um com limitação da PIP e do VT(PIP < 40cm H2O e VT < 10ml/Kg,grupo teste)e outro,exposto a um volume corrente convencional de 10ml/Kg e sem limitação da PIP(grupo controle). Resultado: Apesar de valores muito diferentes da PIP e do Vt respectivamente para os grupos teste e controle(28.9 + - 3.64vs 42.3 + - 5.36cm H2O e 7.6 + - 0.92vs 10 + - 1.10 com p < 0.05),a taxa de mortalidade não foi estatísticamente significativa entre os dois grupos s(46.2 por cento vs 50 por cento,p=0.913). A hipercapnia permissiva foi comum em todos os pacientes do grupo de teste(PaCO2=61.4+ - 11.37 mmHg). A incidência de barotrauma foi de 22 por cento. os valores do APACHE II foram respectivamente 23 + - 5 para o grupo teste e de 24 + - 4 para o grupo controle(p = 0.254). Conclusão: A ventilação com limitação do volume corrente e da pressão inspiratória máxima não influenciou a mortalidade em pacientes com SARA e LIS > 2.5